Bello Aminu K, Alrukhaimi Mona, Ashuntantang Gloria E, Bellorin-Font Ezequiel, Benghanem Gharbi Mohammed, Braam Branko, Feehally John, Harris David C, Jha Vivekanand, Jindal Kailash, Johnson David W, Kalantar-Zadeh Kamyar, Kazancioglu Rumeyza, Kerr Peter G, Lunney Meaghan, Olanrewaju Timothy Olusegun, Osman Mohamed A, Perl Jeffrey, Rashid Harun Ur, Rateb Ahmed, Rondeau Eric, Sakajiki Aminu Muhammad, Samimi Arian, Sola Laura, Tchokhonelidze Irma, Wiebe Natasha, Yang Chih-Wei, Ye Feng, Zemchenkov Alexander, Zhao Ming-Hui, Levin Adeera
Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.
Kidney Int Suppl (2011). 2018 Feb;8(2):41-51. doi: 10.1016/j.kisu.2017.10.008. Epub 2018 Jan 19.
Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.
可靠的治理和卫生筹资对于不同国家的卫生系统可持续满足其民众（包括肾病患者）的健康需求的能力至关重要。因此，全面了解现有系统和基础设施对于在全球范围内识别肾脏护理方面的差距并确定优先改进领域是必要的。这项由国际肾脏病学会作为全球肾脏健康地图集的一部分开展的多国横断面调查，考察了世界各地肾脏护理的监督、筹资情况以及对基础设施质量的看法。总体而言，占世界人口93%的125个国家回复了整个调查，其中122个国家回复了与该领域相关的问题。肾脏护理的国家监督在高收入国家最为常见，而个别医院的监督在低收入国家最为常见。非洲和中东部分地区似乎没有有组织的监督系统。肾病患者的医疗保健系统覆盖由公共资金资助且免费的国家比例，在急性肾损伤（56%）、非透析慢性肾病（40%）、透析（63%）和肾移植（57%）方面各不相同，但在低收入国家，尤其是非洲和东南亚，这种情况要少得多，这些地区更多地依赖私人资金，患者需自掏腰包。肾病的早期检测和管理最不可能被纳入筹资模式。在高收入国家中，没有一个国家认为支持急性肾损伤和慢性肾病护理的卫生基础设施质量差至极差，但在超过40%的低收入国家，尤其是非洲，该质量被评为差至极差。这项研究表明，在监督、筹资以及支持肾病患者医疗服务的基础设施方面存在重大差距，尤其是在低收入和中等收入国家。
